Medicare Cuts: Obama vs. Romney

President Obama and Mitt Romney traded sharp jabs on healthcare in the first presidential debate Wednesday night, with each attacking the other's plans on health reform and Medicare.

The first mention of the night for healthcare came in the first half-hour, when Romney said he'd cut "Obamacare" because it wasn't worth the cost. After Romney apologized for using the term Obamacare, the president said, "I like it."

The former Massachusetts governor, unlike his earlier reticence on the subject, didn't shy away from his work to achieve universal coverage in his state. Instead, he said that work wasn't meant to serve as a model for the entire country, although it did seem to do that for the Affordable Care Act (ACA).

"What we did in Massachusetts is a model for the nation state by state," Romney said in the debate at the University of Denver. "I said that at that time."

Obama tried to point out Romney's lack of details on how he would reform healthcare if he repeals the ACA, as he says he would do his first day in office. Obama said Romney has yet to detail exactly what he'd replace the ACA with, and that several of the idea that Romney has outlined, such as coverage of pre-existing conditions, are included in the ACA.

Romney, when asked directly by moderator Jim Lehrer what he plan was for healthcare, said his plan would include making health insurance a free-market system.

"The right answer is not to have the federal government take over healthcare and start mandating to the providers across America telling a patient and a doctor what treatment they can have," Romney said. "The private market and individual responsibility always work best."

Obama championed popular provisions of the ACA, including the coverage of pre-existing conditions, allowing young adults to stay on their parents' plans up to age 26, and removal of lifetime coverage limits.

Romney continued to press Obama on $716 billion in Medicare cuts under the ACA, saying those costs will cause providers to drop out of the program. "Some 15% of hospitals and nursing homes say they won't take any more Medicare patients under that scenario," Romney said. "We also have 50% of doctors who say they won't take any more Medicare patients."

Obama, as he's tried to do in the past, tried to explain those cuts went to reduced payments to hospitals and providers -- payments reductions those groups agreed to.

To counter, Obama hammered Romney's plan to transform Medicare into a voucher system whereby seniors would receive a "premium support" payment allowing them to purchase either traditional fee-for-service Medicare or a private plan.

"The problem is, because the voucher wouldn't necessarily keep up with healthcare inflation, it was estimated that this would cost seniors about $6,000 a year," Obama said.

Keeping traditional Medicare would collapse the system as the private insurers target and enroll the healthier patients, leaving the sicker patients in traditional coverage and driving up its costs, he said.

Romney responded, "Let's see if we can't get competition into the Medicare world so that people can get their choice of different plans at lower costs, better quality. I believe in competition."

For Medicaid, Romney said he would fund the states at what they're receiving now plus inflation and 1% and allow them to decide how to treat their patients.

As a former governor, he believed states could "care for our own people so much better than the federal government," Romney said.

Obama didn't immediately respond to Romney's thoughts on Medicaid.

Romney and Obama weren't the only Presidential candidates responding to the debate questions. In an event sponsored by the radio and television program "Democracy Now," Green Party candidate Jill Stein, MD, and Justice Party candidate Rocky Anderson also gave responses.

Anderson noted that the U.S. is "the only country in the industrialized world that relies on for-profit insurance companies to provide healthcare for our citizens." In addition, "we're paying twice as much per capita [for healthcare] as the rest of the industrialized world, and getting the worst medical outcomes."

Stein noted that both Obama and Romney "are aiming for the same targets ... they want Medicare to be reduced to 3.2% of the Gross Domestic Product."

Neither Anderson nor Stein are fans of the ACA. Stein noted that she lives in Massachusetts, where "We've seen the Affordable Care Act in the flesh, and it's neither affordable nor caring ... it provides stripped-down plans which are fairly expensive."

Anderson said that the answer to the healthcare cost dilemma is "Medicare for everybody; make it a single-payer system. ... Let's get private insurers out of the way."

Wednesday was the first of three presidential debates, with this one focusing entirely on domestic policy.

The next presidential debate is a town hall-style forum Oct. 16 in Hempstead, N.H. The vice presidential debate is set for Oct. 11 in Danville, Ky.

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